title: A prognostic model for soft tissue sarcoma of the extremities and trunk wall based on size, vascular invasion, necrosis, and growth pattern.
abstract: BACKGROUND
  In soft tissue sarcoma, better distinction of high-risk and low-risk patients is needed to individualize treatment and improve survival. Prognostic systems used in clinical practice identify high-risk patients based on various factors, including age, tumor size and depth, histological type, necrosis, and grade.
  
  
  METHODS
  Whole-tumor sections from 239 soft tissue sarcomas of the extremities were reviewed for the following prognostic factors: size, vascular invasion, necrosis, and growth pattern. A new prognostic model, referred to as SING (Size, Invasion, Necrosis, Growth), was established and compared with other clinically applied systems.
  
  
  RESULTS
  Size, vascular invasion, necrosis, and peripheral tumor growth pattern provided independent prognostic information with hazard ratios of 2.2-2.6 for development of metastases in multivariate analysis. When these factors were combined into the prognostic model SING, high risk of metastasis was predicted with a sensitivity of 74% and a specificity of 85%. Moreover, the prognostic performance of SING compared favorably with other widely used systems.
  
  
  CONCLUSIONS
  SING represents a promising prognostic model, and vascular invasion and tumor growth pattern should be considered in soft tissue sarcoma prognostication.
authors.affiliation: Department of Oncology, Institute of Clinical Sciences, Skåne University Hospital, Lund University, Lund, Sweden. ana.carneiro@med.lu.se
authors.forename: Ana
authors.initials: A
authors.lastname: Carneiro
authors.forename: Par-Ola
authors.initials: PO
authors.lastname: Bendahl
authors.forename: Jacob
authors.initials: J
authors.lastname: Engellau
authors.forename: Henryk A
authors.initials: HA
authors.lastname: Domanski
authors.forename: Christopher D
authors.initials: CD
authors.lastname: Fletcher
authors.forename: Pehr
authors.initials: P
authors.lastname: Rissler
authors.forename: Anders
authors.initials: A
authors.lastname: Rydholm
authors.forename: Mef
authors.initials: M
authors.lastname: Nilbert
mesh_terms: D000328:Adult; D000368:Aged; D049109:Cell Proliferation; D003661:Decision Support Techniques; D005121:Extremities; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D008962:Models, Theoretical; D009336:Necrosis; D009367:Neoplasm Staging / Q000379:methods; D009389:Neovascularization, Pathologic / Q000175:diagnosis* / Q000453:epidemiology / Q000473:pathology; D011379:Prognosis; D012509:Sarcoma / Q000098:blood supply / Q000175:diagnosis* / Q000453:epidemiology / Q000473:pathology; D012983:Soft Tissue Neoplasms / Q000098:blood supply / Q000175:diagnosis* / Q000453:epidemiology / Q000473:pathology; D035441:Thoracic Wall; D047368:Tumor Burden / Q000502:physiology*